Neurolytic Caudal Epidural Block for Rectal Tenesmus: A Case Report

Rectal tenesmus is a very uncomfortable symptom. Though antiarrhythmic drugs and nerve blocks have been proposed as a treatment for rectal tenesmus, none is well-established. We report a 68-year-old female who undertook surgery for uterine cervical cancer and underwent chemotherapy. She got a bilateral nephrostomy and bowel obstruction during the chemotherapy because of recurrence. She decided to stop chemotherapy and to receive palliative care. She had a symptom of rectal tenesmus, which was refractory to medications. The clinical sign was severe and uncomfortable, making her very nervous. We planned to treat the rectal tenesmus with a nerve block. A ganglion impar block was insufficient to remove the symptom, and the saddle block failed due to epidural lipomatosis. We finally succeeded in alleviating the sign with a neurolytic caudal epidural block. Relief of tenesmus made her hope to spend her final period at home. She could stay at home with her family for seven days before death without recurrence of the symptom. Though there is no report about the effectiveness of neurolytic caudal epidural block for rectal tenesmus, we consider the block appropriate for the symptom.

Evaluation of the Results of Septum Extension Batten Graft in Patients Referred for Septorhinoplasty

Abstract Introduction Correction of caudal septal deviations has always been a challenging subject in septorhinoplasty. The septum batten extension graft (SBEG) is a new graft that has potential properties in rhinoplasty. However, few reports have evaluated the surgical outcomes of this technique. Objective The purpose of this study was to evaluate the effectiveness of SBEG in correcting caudal septal deviation. Methods This cross-sectional study was conducted on patients with caudal septal deviation undergoing septorhinoplasty using SBEG at 2 different hospitals in 2019. We then retrospectively reviewed medical records and photographs of 50 patients at the preoperative period, as well as at 1-month, and 12-month postoperatively. Gross changes in nasolabial angle, columellar show, nasal tip projection, and dorsal nasal deviation were evaluated by a photographic analysis method, and nasal obstruction was assessed by patient satisfaction with breathing. Results There was a significant difference between the mean nasolabial angle and columellar show at 1 and 12-months postoperatively, compared with the previous values (p < 0.0001). The nasolabial angles were in a favorable position with an increase of 12 to 15 degrees compared with the preoperative state. The columellar show also improved by an average of 1.2 mm and was in good condition. The postoperative dorsal nasal deviation was significantly reduced, and projection was significantly increased (3.521 ± 0.087 mm vs. 0.719 ± 0.028; p < 0.0001; p < 0.001 ). Moreover, this method had a significant favorable effect on nasal obstruction (p = 0.049). Conclusion Our results showed that septorhinoplasty using SBEG is useful for correcting caudal septal deviation, with favorable surgical outcomes, and it has responded well to all five aforementioned criteria.

Síndrome de regresión caudal en diabetes materna: reporte de caso / Caudal regression syndrome in maternal diabetes: case report

Resumen ANTECEDENTES: La diabetes mellitus sigue siendo una enfermedad de gran prevalencia mundial; en México alcanza el 13.7% y, de este porcentaje, el 30% ignora que la padece. Esta circunstancia se ha asociado con complicaciones durante el embarazo: malformaciones congénitas por hiperglucemia en el primer trimestre del embarazo y el síndrome de regresión caudal, entre otras. A pesar de los avances en el diagnóstico y tratamiento de esta enfermedad metabólica, estas alteraciones siguen provocando discapacidad, de ahí la importancia de su identificación temprana en el embarazo. CASO CLÍNICO: Paciente de 35 años, primigesta, con diagnóstico de diabetes tipo 2 establecido en el primer trimestre del embarazo, con hemoglobina glucosilada de 7.6%. En el ultrasonido estructural se observaron datos compatibles con el síndrome de regresión caudal y alteraciones severas en las extremidades. Al nacimiento, a las 18 semanas, se confirmó la luxación importante de las extremidades inferiores. CONCLUSIÓN: En la primera consulta prenatal debe practicarse el tamizaje para diabetes, sobre todo en pacientes con alto riesgo. Luego del diagnóstico son importantes los ultrasonidos de segundo nivel para detectar anomalías. La educación a la paciente es decisiva para el adecuado control metabólico y prevención de complicaciones durante el embarazo.

Abstract BACKGROUND: Diabetes mellitus continues to be a disease of high prevalence worldwide; in Mexico it reaches 13.7% and, of this percentage, 30% are unaware that they suffer from it. This circumstance has been associated with complications during pregnancy: congenital malformations due to hyperglycaemia in the first trimester of pregnancy and caudal regression syndrome, among others. Despite advances in the diagnosis and treatment of this metabolic disease, these alterations continue to cause disability, hence the importance of early identification in pregnancy. CLINICAL CASE: 35-year-old primigravida patient with a diagnosis of type 2 diabetes established in the first trimester of pregnancy, with a glycosylated haemoglobin of 7.6%. Structural ultrasound showed data compatible with caudal regression syndrome and severe alterations in the extremities. At birth, at 18 weeks, severe dislocation of the lower extremities was confirmed. CONCLUSION: Screening for diabetes should be performed at the first prenatal visit, especially in high-risk patients. After diagnosis, second level ultrasound is important to detect abnormalities. Patient education is crucial for adequate metabolic control and prevention of complications during pregnancy.

A COMPARATIVE STUDY BETWEEN CAUDAL ROPIVACAINE AND ROPIVACAINE PLUS DEXAMETHASONE FOR INFRAUMBILICAL SURGERY IN PEDIATRIC PATIENTS

Background: Caudal block is one of the most popular regional block in children with high success rate for infra-umbilical surgeries. Among local anaesthetics ropivacaine provides a greater margin of safety, less motor blockade, less neurological and cardiac toxicity and similar duration of analgesia compared to bupivacaine. Addition of dexamethasone as an additive to local anesthesia decreases the postoperative rescue analgesia consumption.This study was designed to compare the effectiveness of intra-operative and postoperative analgesia on adding dexamethasone to 0.15% ropivacaine with 0.15%ropvacaine given alone. A prospective double blinded Materials: randomised controlled study was conducted consisting of 60 patients undergoing infra-umbilical surgeries under general anesthesia with Caudal block. Patients were randomised into two groups. Group A received 0.15% Inj.ropivacaine 1.5ml/kg with 1ml normal saline and Group B received 0.15% Inj.Ropivacaine 1.5ml/kg with 0.1mg/kg Inj.dexamethasone in caudal block Mean FLACC pain score was comparable and statistically not signi?cant (P=0.083) in both groups upto 30min Results: postoperatively. At 60min mean pain score in group A was 0.30 ± 0.54 and in group B was 0 (P=0.005) which was statistically signi?cant. In group A 40%(12) patients required rescue analgesia whereas in group B only 10%(3) patients required analgesia(P= 0.007) Patients remained hemodynamically stable throughout the procedure. After 60min Conclusion: postoperatively FLACC score was signi?cantly higher in group A as compared to group B. It concludes that addition of dexamethasone signi?cantly reduced postoperative pain and need for rescue analgesia without any side effects.

Effect of environmental characteristics on the diversity of aquatic macroinvertebrates in Andean rivers regulated for hydroelectric generation / Efecto de características ambientales en la diversidad de macroinvertebrados acuáticos en ríos andinos regulados para generación hidroeléctrica

Introduction: The Andes are characterized by an abundance of water resources and flows are frequently regulated by reservoirs for the generation of energy. The effects of regulation on aquatic macroinvertebrate communities are not well known in Colombia. Objective: To test the hypothesis that regulated currents have less macroinvertebrate diversity. Methods: We collected water and organism samples before, and after, the regulation of the Tafetanes, Calderas and Arenosa rivers, in Antioquia, Colombia, during various hydrological cycles (rain, transition and drought) and climatic phenomena (ENSO/El Niño Phenomenon) between 2016 and 2018. Results: We collected 53 214 individuals, from 165 taxa, mostly from the orders Ephemeroptera, Plecoptera, Trichoptera and Diptera (90 % of captures). Changes in diversity responded to spatial differences rather than to physicochemical variables: diversity was higher in non-regulated sites, regardless of the hydrological period or associated ENSO. Most species were found in all sampling sites, but abundance was higher in the site with the best habitat conservation status. Conclusion: The results support the hypothesis that physical barriers have effects on macroinvertebrate diversity at the local scale, however, the condition of adjacent habitats also seems to play an important role in preserving richness and abundance. The conservation of forest adjacent to the riverbed could mitigate the impacts of regulation.

Introducción: Los Andes se caracterizan por tener gran abundancia de recursos hídricos y las corrientes son frecuentemente reguladas por embalses para la generación de energía. Los efectos de la regulación en las comunidades de macroinvertebrados acuáticos no se conocen bien en Colombia. Objetivo: Probar la hipótesis de que las corrientes reguladas presentan menor diversidad de macroinvertebrados. Métodos: Recolectamos muestras de agua y organismos, antes y después de la regulación de los ríos Tafetanes, Calderas y La Arenosa, en Antioquia, Colombia, durante varios ciclos hidrológicos (lluvia, transición y sequía) y fenómenos climáticos (ENSO/Fenómeno de El Niño) entre 2016 y 2018. Resultados: Recolectamos 53 214 individuos, de 165 táxones, en su mayoría de los órdenes Ephemeroptera, Plecoptera, Trichoptera y Diptera (90 % de las capturas). Los cambios en la diversidad respondieron a las diferencias espaciales más que a las variables fisicoquímicas: la diversidad fue mayor en sitios no regulados, independientemente del periodo hidrológico o del ENSO. La mayoría de las especies se encontraron en todos los sitios de muestreo, pero su abundancia fue mayor en el sitio de mejor estado de conservación del hábitat. Conclusiones: Los resultados apoyan la hipótesis de que las barreras físicas tienen efectos sobre la diversidad de macroinvertebrados a escala local, sin embargo, el estado de los hábitats adyacentes también parece jugar un papel importante en la preservación de la riqueza y abundancia. La conservación del bosque adyacente podría mitigar los impactos generados por la regulación.

Sirenomelia

Sirenomelia is a rare and fatal congenital defect characterized by varying degrees of lower limb fusion, thoracolumbar spinal anomalies, sacrococcygeal agenesis, genitourinary, and anorectal atresia. We report a case of baby, born with narrow chest, bilateral hypoplastic thumb, fused lower limbs with a single foot and 5 toes, absent external genitalia, imperforate anus and umbilical cord with single umbilical artery. When diagnosed antenatally, termination should be offered

Manejo anestésico en neonatos con tumoraciones pulmonares / Anesthetic management in neonates with lung tumors

Resumen: Introducción: Los tumores pulmonares congénitos son patologías poco frecuentes; asimismo, cuando requieren intervención quirúrgica, el médico anestesiólogo se enfrenta a un reto en el manejo de estos pacientes. Presentación del caso: En este artículo describimos el caso y el manejo anestésico de un recién nacido de 37.5 semanas de gestación (SDG) y 26 días de vida extrauterina, programado para toracotomía posterolateral izquierda más lobectomía inferior izquierda y colocación de catéter venoso central bajo anestesia combinada (anestesia general balanceada más bloqueo caudal con bupivacaína y morfina). Conclusiones: Las consideraciones anestésicas para los procedimientos quirúrgicos en neonatos y/o pacientes pediátricos se convierten en un reto para el anestesiólogo, debido a la inmadurez de algunos de los sistemas, se considera que la técnica anestésica idónea para el adecuado manejo de los pacientes neonatales sigue siendo la técnica combinada. El anestesiólogo debe mantener en mente dicha técnica así como los eventos y/o efectos secundarios que se puedan derivar de la misma y de este modo instaurar de manera oportuna el tratamiento pertinente.

Abstract: Introduction: Congenital lung tumors are rare pathologies, likewise when surgical intervention is required, the anesthesiologist faces a challenge in the anesthetic management of these patients. Presentation of the case: The following article describes the case of a 26-day-old newborn child scheduled for left posterolateral thoracotomy plus lower left lobectomy and central venous catheter placement under combined anesthesia (balanced general anesthesia plus caudal block with bupivacaine and morphine). Conclusions: Anesthetic considerations for surgical procedures in neonates and/or pediatric patients become a challenge for the anesthesiologist, due to the immaturity of some of the systems, thus considering that the ideal anesthetic technique for the proper management of in neonatal patients, the combined technique continues, with epidural blocks for the management of peri- and postoperative pain. The anesthesiologist must keep in mind this technique as well as the events and/or side effects that may derive from it, thus establishing the pertinent treatment in a timely manner.

Anesthesia in a child with arthrogryposis multiplex congenita – how to proceed: A case report

Arthrogryposis multiplex congenita (AMC) consists of a heterogenous group of disorders characterized by non-progressive congenital joint contractures. They have tense skin, minimal subcutaneous tissue, and muscle mass. The anesthetic management of these children is complicated by associated congenital abnormalities, airway anomalies, congenital heart disease, pulmonary hypoplasia, and vertebral anomalies. We managed a case of AMC with bilateral contractures of both upper and lower limb and neck who presented for correction of bilateral equino varus.

Caudal regression syndrome: A rare case report with review of the literature

Caudal regression syndrome is a very rare neural tube disorder, in which the caudal vertebral column and spinal cord develop abnormally, causing substantial sensory and motor deficits, primarily in the legs. An abnormality in the spinal cord and nerve roots interacts with a section of lumbar, lumbosacral, or coccygeal spinal dysgenesis or agenesis. Here, we present a rare case of caudal regression syndrome in a 3-year-old male child who was brought to the pediatrics department with a serious complaint of urine dribbling since infancy. The infant was discovered with spina bifida, lumbar scoliosis, and cavus deformity in both feet during a routine health check. For which, a neurological opinion was taken. Plain X-ray revealed a partial sacral agenesis, MRI revealed anterior and posterior nerve roots of cauda equina divided into two bundles of fibers due to abnormal path. The lower back and both gluteal areas were underdeveloped. On the basis of radiological findings, a diagnosis of the syndrome was confirmed.

Assessment of Stress Response Attenuation with Caudal Morphine Using a Surrogate Marker During Pediatric Cardiac Surgery

Background:Measurement of biomarkers representing sympathetic tone and the surgical stress response are helpful for objective comparison of anesthetic protocols. Aims: The primary aim was to compare changes in chromogranin A levels following pump pediatric cardiac surgery between children who received bolus caudal morphine and those who received a conventional intravenous narcotic?based anesthesia regime. The secondary objectives were to compare hemodynamic responses to skin incision and the magnitude of the rise in blood sugar values between the groups. Settings and Design: A prospective observational study at a tertiary cardiac center. Measurements and Methods: Sixty pediatric cardiac surgical patients were randomized to Group I [n = 30] to receive intravenous narcotic?based anesthesia and Group II [n = 30] to receive single?shot caudal morphine. Baseline and postoperative chromogranin A levels, the hemodynamic response to skin incision, changes in blood sugar levels, and the total intravenous narcotic dose administered were recorded for each participant. Statistical Analysis: Pearson’s Chi?squared test was used for comparison of categorized variables, and Mann–Whitney test was used for the analysis of continuous data. Results: Changes in chromogranin A levels and blood sugar levels were comparable in both groups. Group II received a lower narcotic dosage (P ? 0.001), and the response to skin incision as reflected by systolic pressure rise was less (P = 0.006). Conclusions: Surgical stress response attenuation was similar to caudal morphine as compared with intravenous narcotic?based anesthesia techniques as reflected by a similar increase in chromogranin A levels

CAUDAL MIGRATION AND TRANS-ANAL EXTRUSION OF VENTRICULOPERITONEAL SHUNT IN A CHILD : A CASE REPORT

We present an unusual case of anal extrusion of the peritoneal end of a ventriculo-peritoneal shunt (VP shunt) in a 5 year old male child. The patient was suffering from aqueductal stenosis for which the shunt was placed 2 years ago. Pertinent literature is reviewed regarding this rare complication in such a common surgery.

Evaluación microbiológica del caudal de impulsión y extracción mecánica en habitaciones hospitalarias de aislados infecciosos e inmunodeprimidos / Microbiological evaluation of the discharge flow and mechanical extraction in hospital rooms of infectious and immunosuppressed isolates

Por las particularidades de los hospitales, su entorno contiene un gran número de microorganismos proporcionando condiciones muy favorables para la reproducción y la propagación de microorganismos patógenos. Por otro lado, como un sitio importante del uso de antibióticos, las infecciones asociadas a hospitales y la resistencia a los antimicrobianos promueven mutuamente la formación de un círculo vicioso. Existen fuertes evidencias de que la transmisión por aire y aerosoles de los microorganismos patógenos están muy extendidos en los entornos hospitalarios. En ese sentido, las partículas transportadas por el aire se caracterizan por su baja densidad, invisibilidad y susceptibilidad a la turbulencia. El asentamiento de partículas infecciosas en el aire sobre la herida de un paciente puede causar infecciones en cirugía o en caso más graves, infectar a pacientes con sistemas inmunológicos comprometidos, o puede conducir, si las condiciones de ventilación no son apropiadas, a la diseminación de bacterias y hongos (bioaerosoles) desde pacientes infecciosos a toda la comunidad hospitalaria. Para mejorar el estado de estas infecciones asociadas a los hospitales, los sistemas tradicionales se han centrado en estrategias para eliminar patógenos presentes en pacientes, superficies clínicas y trabajadores de la salud, que ha impulsado la implementación de varios protocolos de control y desinfección de infecciones que también han tenido éxito en la reducción de la incidencia de este tipo de infecciones hospitalarias. Dentro de estos procedimientos, está el uso de sistema de ventilación con presión de aire positiva o negativa El objetivo de este trabajo es determinar la capacidad de control microbiano de los sistemas de ventilación en dos centros de asistencia médica del Perú en habitaciones con pacientes inmunosuprimidos (VIH/Sida) aislados o en habitaciones de pacientes infecciosos(AU)

Due to the particularities of hospitals, their environment contains a large number of microorganisms, providing very favorable conditions for the reproduction and spread of pathogenic microorganisms. On the other hand, as an important site of antibiotic use, hospital-associated infections and antimicrobial resistance mutually promote the formation of a vicious circle. There is strong evidence that airborne and aerosol transmission of pathogenic microorganisms is widespread in hospital settings. In that sense, airborne particles are characterized by their low density, invisibility, and susceptibility to turbulence. The settling of airborne infectious particles on a patient's wound can cause infections in surgery or, in more serious cases, infect patients with compromised immune systems, or can lead, if ventilation conditions are not appropriate, to the spread of pathogens. bacteria and fungi (bioaerosols) from infectious patients to the entire hospital community. To improve the status of these hospital-associated infections, traditional systems have focused on strategies to eliminate pathogens present in patients, clinical surfaces, and healthcare workers, which has prompted the implementation of various infection control and disinfection protocols that they have also been successful in reducing the incidence of this type of hospital infection. Within these procedures, there is the use of a ventilation system with positive or negative air pressure. The objective of this work is to determine the microbial control capacity of the ventilation systems in two medical care centers in Peru in rooms with immunosuppressed patients (HIV/AIDS) isolated or in infectious patient rooms(AU)

Bioestructura de la piel de la aleta caudal del salmón del atlántico, en estado smolt y sus interacciones con el estado chalimus del Caligus rogercresseyi / Biostructure of the atlantic salmon skin of the caudal fin, in the smolt stage and its interactions with the chalimus stage of Caligus rogercresseyi

RESUMEN: Caligus rogercresseyi es un copépodo que representa uno de los principales desafíos de la industria del cultivo de salmónidos en Chile, ya que afecta profusamente a la piel. Es preciso destacar que los peces en agua dulce y estuario no son afectados, a diferencia del salmón, que desde el post-smolt resulta muy parasitado cuando es trasladado al mar. Se han realizado múltiples estudios sobre el ciclo de vida del parásito y desarrollado tratamientos químicos, físicos y mecánicos para eliminarlos. Sin embargo, a la fecha, los tratamientos no han sido eficaces, lo que produce un problema permanente para el bienestar del animal. El propósito de este estudio fue el de reconocer la bioestructura de la piel de la aleta caudal del salmón del atlántico en los sitios de la interacción con chalimus. Para esto, se utilizaron 15 post-smolt infectados con Caligus y 5 post-smolt controles, sin Caligus. Los salmones fueron aportados por Fundación Chile y la experiencia se realizó en su propio centro experimental. Una vez realizada la eutanasia, mediante sobredosis del anestésico benzocaína, se obtubieron muestras de las aletas caudales, las cuales fueron fijadas en formalina al 10%, incluidas en paraplast para realizar cortes de 5 µm de espesor y teñidas con Tricrómico de Masson y PAS. Los resultados indicaron que la piel de la aleta caudal de los post-smolt afectados presentan mayor altura de la epidermis, escasa células secretoras de mucus y solución de continuidad en la epidermis. Además, la membrana basal se descontinúa y ocurre un aumento de melanomacrófagos en la dermis.

SUMMARY: Caligus rogercresseyi is a copepod that represents one of the main challenges of the salmon farming industry in Chile, since it profusely affects the skin. It should be noted that fish in freshwater and estuaries are not affected, unlike salmon, which from post-smolt is highly parasitized when transferred to the sea. Multiple studies have been carried out on the life cycle of the parasite and chemical, physical and mechanical treatments have been developed to eliminate them. However, to date, the treatments have not been effective, which produces a permanent problem for the welfare of the animal. The purpose of this study was to recognize the biostructure of Atlantic salmon caudal fin skin at sites of interaction with chalimus. For this, 15 post-smolt infected with Caligus and 5 post-smolt controls, without Caligus, were used. The salmon were provided by Fundación Chile and the experience was carried out in its own experimental center. Once the euthanasia was carried out, by means of an overdose of the anesthetic benzocaine, samples of the caudal fins were obtained, which were fixed in 10 % formalin, included in paraplast to make 5 µm-thick sections and stained with Masson's Trichrome and PAS. The results indicated that the skin of the caudal fin of the affected post-smolt presented a greater height of the epidermis, few mucus-secreting cells and a solution of continuity in the epidermis. In addition, the basement membrane is discontinued and an increase in melanomacrophages occurs in the dermis.

Comparison of dorsal penile nerve block and caudal block for postoperative analgesic efficacy in pediatric patients undergoing penile surgery with general anesthesia: a meta-analysis / 中华麻醉学杂志

Objective:To systematically evaluate the efficacy of dorsal penile nerve block (DPNB) and caudal block (CB) for analgesia after penile surgery under general anesthesia in the pediatric patients.Methods:Databases including PubMed, EMbase, Web of Science, the Cochrane Library, Wanfang, VIP, CNKI and CBM were searched to collect the randomized controlled trials involving DPNB and CB for penile surgery under general anesthesia in children from inception to September 2021.Meta-analysis was performed using RevMan 5.4 software.Results:Sixteen randomized controlled trials involving 1 271 pediatric patients were enrolled.The results of meta-analysis showed that the requirement for analgesic drugs during recovery was significantly lower in CB group than in DPNB group ( RR=2.54, 95% CI 1.19-5.40, P=0.020); the time of first postoperative activity was significantly shortened ( SMD=-0.68, 95% CI -1.23--0.13, P=0.020), and the incidence of postoperative motor block was decreased ( RR=0.05, 95% CI 0.01-0.16, P<0.001) in DPNB group as compared with CB group.There were no significant differences in the incidence of intraoperative block failure ( RR=1.25, 95% CI 0.62-2.51, P=0.530) between two groups.There were no significant differences in objective pain scores at awakening ( SMD=-0.29, 95% CI -0.01-0.59, P=0.050), at 1 h after surgery ( SMD=1.02, 95% CI -1.37-3.41, P=0.400), or at 2 h after surgery ( SMD=0.05, 95% CI -0.59-0.68, P=0.880) between two groups.There were no significant differences in the incidence of agitation during recovery ( RR=0.71, 95% CI 0.44-1.14, P=0.150) between two groups.There were no significant differences in the time of first urination ( MD=-84.52, 95% CI -195.72-26.69, P=0.140) between two groups.There were no significant differences in the incidence of postoperative nausea and vomiting ( RR=0.56, 95% CI 0.29-1.07, P=0.080) between two groups. Conclusions:DPNB and CB provide similar postoperative analgesic efficacy, but DPNB can prevent the occurrence of postoperative motor block, which is helpful for the postoperative rehabilitation in the pediatric patients undergoing penile surgery with general anesthesia.

Combined application of intraspinal analgesia, bilateral pudendal nerve block anesthesia and modified perineal protection in midwifery / 中国基层医药

Objective:To investigate the clinical efficacy of intraspinal analgesia, pudendal nerve block anesthesia and modified perineal protection in combination in midwifery.Methods:A total of 160 primiparous women who were subjected to full-term vaginal delivery in Suqian Hospital of Nanjing Drum Tower Hospital Group between January 2019 and January 2021 were included in this study. They were randomly assigned to undergo either bilateral pudendal nerve block combined with modified perineal protection (control group, n = 80) or intraspinal analgesia, pudendal nerve block anesthesia and modified perineal protection in combination (observation group, n = 80). Each clinical index was compared between the control and observation groups. Results:Duration of labor in the observation group was significantly shorter than that in the control group [(7.23 ± 2.11) hours vs. (9.35 ± 3.79) hours, t = 4.27, P < 0.05). Cesarean section rate in the observation group was significantly lower than that in the control group [8.7% (7/80) vs. 52.5% (42/80), χ 2 = 17.18, P < 0.05]. Incidence of perineal tears in the observation group was significantly lower than that in the control group [8.7% (7/80) vs. 32.5% (26/80), χ 2 = 15.48, P < 0.05]. Third-degree perineal tears occurred in neither group. Time of postpartum off-bed ambulation and length of postpartum hospital stay in the observation group were (1.37 ± 0.13) days and (3.22 ± 0.31) days, respectively, which were significantly shorter than those in the control group [(2.52 ± 0.22) days, (5.23 ± 0.62) days, t = 25.90, 25.94, both P < 0.05). The incidence of complications in the observation group was significantly lower than that in the control group [7.5% (6/80) vs. 23.7% (19/80), χ 2 = 8.01, P < 0.05]. There were no significant differences in incidence of neonatal asphayxia, 2-hour postpartum hemorrhage and postpartum hemorrhage between the two groups (all P > 0.05). Conclusion:During midwifery of full-term vaginal delivery, combined application of intraspinal analgesia, bilateral pudendal nerve block anesthesia and modified perineal protection can shorten duration of labor and decrease cesarean section rate.

Glutamatergic Neurons in the Caudal Zona Incerta Regulate Parkinsonian Motor Symptoms in Mice / 神经科学通报·英文版

Parkinson's disease (PD) is the second most common and fastest-growing neurodegenerative disorder. In recent years, it has been recognized that neurotransmitters other than dopamine and neuronal systems outside the basal ganglia are also related to PD pathogenesis. However, little is known about whether and how the caudal zona incerta (ZIc) regulates parkinsonian motor symptoms. Here, we showed that specific glutamatergic but not GABAergic ZIc

Anestesia peridural caudal en neonatos: una alternativa segura para el anestesiólogo / Caudal peridural anesthesia in neonates: a safe alternative for the anesthesiologist

Introducción: Las técnicas de anestesia y analgesia regional en la población pediátrica garantizan la estabilidad hemodinámica y respiratoria. El uso de la anestesia caudal ha aumentado enormemente sobre todo para cirugías de abdomen inferior lo que ofrece ventajas sobre la anestesia general. Objetivo: Argumentar sobre la base de la mejor evidencia científica, la opinión de los autores en relación a la efectividad del uso de la anestesia caudal en los pacientes neonatos. Método: El marco inicial de búsqueda bibliográfica se constituyó por los artículos publicados acerca de la utilización de la anestesia caudal en neonatos. Las fuentes de información que se utilizaron fueron: Registro Cochrane central de ensayos clínicos controlados, Pubmed, LILACS, SciELO, Ebsco, Science, Google académico. Resultados: El bloqueo caudal es la aplicación de un anestésico local en el espacio peridural, pero a nivel sacro, lo que ocasiona un bloqueo de conducción en las raíces nerviosas que cubre la analgesia, no solo el período intraoperatorio sino también el posoperatorio, lo cual permite una adecuada estabilidad hemodinámica, reduce el sangrado, evita el uso de opioides, anestésicos generales y relajantes musculares. La necesidad de asistencia respiratoria se ve reducida. Conclusiones: Es una técnica segura y económica en ocasiones subvalorada en el recién nacido. Esto, junto a una más rápida recuperación, lleva a considerar la anestesia regional como una alternativa a la anestesia general(AU)

Introduction: Regional anesthesia and analgesia techniques in the pediatric population guarantee hemodynamic and respiratory stability. The use of caudal anesthesia has increased enormously, especially for lower abdominal surgeries, which offers advantages over general anesthesia. Objective: To argue, based upon the best scientific evidence, the opinion of the authors regarding the effectiveness of the use of caudal anesthesia in neonatal patients. Method: The initial framework for the bibliographic search consisted of the articles published about the use of caudal anesthesia in neonates. The sources of information were the Cochrane Central Register of Controlled Trials, Pubmed, LILACS, SciELO, Ebsco, Science, Google Scholar. Results: Caudal block is the application of a local anesthetic into the epidural space, but at the sacral level, which causes a conduction block in the nerve roots that covers analgesia, not only in the intraoperative period but also in the postoperative one, which allows adequate hemodynamic stability, reduces bleeding, avoids the use of opioids, general anesthetics and muscle relaxants. The need for respiratory support is reduced. Conclusions: It is a safe and economical technique, sometimes undervalued in the newborn. This, together with a faster recovery, leads to considering regional anesthesia as an alternative over general anesthesia(AU)

Diferentes técnicas para colocação de enxerto de extensão caudal em rinoplastia / Different techniques for caudal extension graft placement in rhinoplasty

Resumo Introdução: O enxerto de extensão caudal é geralmente um enxerto de cartilagem que se sobrepõe à margem caudal do septo nasal. Uma combinação do enxerto de extensão caudal e a técnica de tongue-in-groove é usada para estabilizar a base nasal, definir a projeção da ponta e refinar a relação alar-columelar. Objetivo: Apresentar algumas novas modificações na colocação dos enxertos de extensão caudal na rinoplastia. Método: Revisão retrospectiva de um banco de dados prospectivamente coletado de 965 pacientes que se submeteram a rinosseptoplastia de junho de 2011 a julho de 2015. Desses, 457 pacientes necessitaram de enxerto de extensão caudal e foram incluídos no estudo. O seguimento mínimo foi de 13,2 meses, com tempo médio de seguimento de 17,4 meses. Resultados: Na maioria dos casos, a comparação das fotografias antes e após a cirurgia foi satisfatória e apresentou melhora do contorno. Pequenas deformidades foram detectadas em 41 pacientes e 11 pacientes necessitaram de cirurgia de revisão. Conclusão: Com essas modificações, o cirurgião pode usar o enxerto de extensão caudal mesmo em desvios angulares do septo caudal. Vários métodos têm sido propostos para correção do desvio septo-caudal.

Towards a complete classification of the Neotropical thorny catfishes (Siluriformes: Doradidae)

We propose a revised classification of Doradidae based on phylogenetic analyses of sequence data for one nuclear (rag1) and two mitochondrial (co1, 16s) genes, and corroborated by caudal-fin morphology. The molecular dataset comprises 174 doradid specimens representing all 31 valid genera, 83 of the 96 valid extant species and 17 species-level taxa that remain undescribed or nominally unassigned. Parsimony and Bayesian analyses of molecular data support six major lineages of doradids assigned here to three nominal subfamilies (Astrodoradinae, Doradinae, Wertheimerinae) and three new ones (Acanthodoradinae, Agamyxinae, Rhinodoradinae). The maximum parsimony topology of Doradidae was sensitive to ingroup density and outgroup age. With the exceptions of Astrodoradinae and Doradinae, each subfamily is diagnosed by caudal-fin characteristics. The highest degree of fusion among skeletal elements supporting the caudal fin is observed in Acanthodoradinae and Aspredinidae, lineages that are sister to the remaining doradids and aspredinoids (i.e., Auchenipteridae + Doradidae), respectively. Fusion among caudal-fin elements tends to be higher in taxa with rounded, truncate or emarginate tails and such taxa typically occupy shallow, lentic habitats with ample structure. Caudal-fin elements are more separated in taxa with moderately to deeply forked tails that occupy lotic habitats in medium to large river channels.(AU)

Propomos uma classificação revisada de Doradidae baseada na análise filogenética de dados moleculares dos genes rag1, co1 e 16s, e suportada pela morfologia da nadadeira caudal. A matriz molecular inclui 174 espécimes de doradídeos representando os 31 gêneros válidos, 83 das 96 espécies viventes e 17 táxons não descritos ou nominalmente não designados. As análises de parcimônia e bayesiana suportam seis linhagens principais de doradídeos atribuídas a três subfamílias nominais (Astrodoradinae, Doradinae, Wertheimerinae) e três novas subfamílias (Acanthodoradinae, Agamyxinae, Rhinodoradinae). A árvore de máxima parcimônia de Doradidae é sensível à densidade de grupo interno e a idade do grupo externo. Com exceção de Astrodoradinae e Doradinae, cada subfamília é diagnosticada por características da nadadeira caudal. Dentro da família Doradidae e da superfamília Aspredinioidea (Aspredinidae, Auchenipteridae e Doradidae), o maior grau de fusão entre os elementos da nadadeira caudal é observado nas linhagens mais antigas, Acanthodoradinae e Aspredinidae, respectivamente. A fusão entre os elementos da nadadeira caudal é maior em táxons com a caudal arredondada, truncada ou emarginada e esses táxons normalmente ocupam habitats lênticos rasos. Os elementos da nadadeira caudal são mais separados em táxons com a cauda bifurcada ocupando habitats lóticos em canais de rios médios a grandes.(AU)

A new species of Bryconops (Characiformes: Iguanodectidae) from Atlantic coastal drainages of Suriname and French Guiana

ABSTRACT A new species of Bryconops is described based on its unique caudal-fin color pattern, with a dark blotch occupying the mid-basal region of the caudal-fin dorsal lobe, and a combination of 29-32 branched anal-fin rays, 44-47 perforated scales in the lateral line, six rows of scales above the lateral line, and a deep body (30.3-31.7 % SL). The new species belongs to the subgenus Bryconops based on its edentulous and short maxilla, with the posterior extension of that bone not reaching the junction between the second and third infraorbitals. The new species was previously reported in the literature as B. caudomaculatus. However, these species differ from each other in morphometric and meristic characters, as well as in color pattern. Comments on distribution of Bryconops species in coastal drainages of Suriname and French Guiana additional support for biogeographic hypotheses in this area.

RESUMO Uma nova espécie de Bryconops é descrita com base no colorido único da nadadeira caudal, com uma mancha escura ocupando a região médio-basal do lobo superior da nadadeira caudal, e uma combinação de 29-32 raios ramificados na nadadeira anal, 44-47 escamas perfuradas na linha lateral, seis séries de escamas acima da linha lateral e corpo alto (30,3-31,7 % CP). A nova espécie pertence ao subgênero Bryconops com base na maxila edêntula e curta, com extensão posterior deste osso não atingindo a junção entre segundo e terceiro infraorbitais. A nova espécie foi reportada anteriormente na literatura como B. caudomaculatus. Contudo, essas espécies diferem uma da outra em caracteres merísticos e morfométricos, bem como no padrão de coloração. Comentários sobre a distribuição das espécies de Bryconops em drenagens costeiras do Suriname e Guiana Francesa fornecem suporte adicional para as hipóteses biogeográficas nesta área.